Fee-for-Service Rate Schedule: Quick ... - State of New Jersey

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New Jersey Department of Human Service. Division of ... Service Description / Tier. Standard Rate per. Unit ... Fiscal M
New Jersey Department of Human Service Division of Developmental Disabilities www.nj.gov/humanservices/ddd

Fee-for-Service Rate Schedule: Quick Reference Guide

Waiver Service

Assistive Technology

Behavioral Supports Career Planning Cognitive Rehabilitation Community Based Supports

Community Inclusion Services

* Service Description / Tier Evaluation Purchase / Customize / Repair / Replace Remote Monitoring Assessment / Plan Development Monitoring Base Base Base Acuity Differentiated Self-Directed Employee Tier A Tier B Tier C Tier D Tier E

Community Transition Services

Day Habilitation

Tier A Tier A / Acuity Differentiated Tier B Tier B / Acuity Differentiated Tier C Tier C / Acuity Differentiated Tier D Tier D / Acuity Differentiated Tier E Tier E / Acuity Differentiated

Environmental Modifications Fiscal Management Service Goods & Services

Individual Supports (Licensed Setting)

Tier A Tier A / Acuity Differentiated Tier B Tier B / Acuity Differentiated Tier C Tier C / Acuity Differentiated Tier D Tier D / Acuity Differentiated Tier E Tier E / Acuity Differentiated

Single

** Waiver Program 46 07

R&C

Single

46

07

T2028HI22

R&C

Single

46

07

T2029HI

$19.60

15 Minutes

46

07

H0004HI22

$7.34 $13.25 $36.50 $7.01 $11.89 R&C $2.36 $2.99 $3.73 $5.60 $7.46 R&C $2.36 $3.43 $2.99 $4.35 $3.73 $5.43 $5.60 $8.15 $7.46 $10.87 R&C To Be Determined R&C $70.52 $149.84 $141.04 $299.68 $235.07 $499.46 $329.10 $699.25 $423.13 $899.04

15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes Single 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes Single Month Single Daily Daily Daily Daily Daily Daily Daily Daily Daily Daily

46 46 46 46 46 46 46 46 46 46 46 n/a 46 46 46 46 46 46 46 46 46 46 46 46 46 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

07 07 n/a n/a n/a n/a n/a n/a n/a n/a n/a 07 07 07 07 07 07 07 07 07 07 07 07 07 n/a 07 07 07 07 07 07 07 07 07 07

H0004HI H2014HI 97532HI H2021HI H2021HI22 H2021HI52 H2015HIU1 H2015HIU2 H2015HIU3 H2015HIU4 H2015HIU5 T2038HI22 T2021HIUS T2021HIU1 T2021HIUR T2021HIU2 T2021HIUQ T2021HIU3 T2021HIUP T2021HIU4 T2021HIUN T2021HIU5 S5165HI T2040HI22 T1999HI22 H2016HI52 H2016HIU1 H2016HIUS H2016HIU2 H2016HIUR H2016HIU3 H2016HIUQ H2016HIU4 H2016HIUP H2016HIU5

Standard Rate per Unit R&C

Billing Unit

Medicaid Code T2028HI

R&C = Reasonable and Customary * Use of Tier and Acuity Differentiated rates are determined through completion of the New Jersey Comprehensive Assessment Tool (NJ CAT) ** Waiver Program: Code "46" refers to the Supports Program under the Comprehensive Medicaid Waiver and Code "07" refers to the Division of Developmental Disabilities Community Care Waiver (CCW)

NJ DHS - DDD For Use: July 1, 2015

1

New Jersey Department of Human Service Division of Developmental Disabilities www.nj.gov/humanservices/ddd

Fee-for-Service Rate Schedule: Quick Reference Guide

Waiver Service Individual Supports (Own Home)

Interpreter Services

* Service Description / Tier Base Acuity Differentiated Self-Directed Employee American Sign Language (ASL) Other - Non-ASL Self-Directed Employee

Natural Supports Training Occupational Therapy Personal Emergency Response System (PERS) Physical Therapy

Prevocational Training

Respite Speech, Language and Hearing Therapy Support Coordination

Supported Employment

Supports Brokerage Transportation Vehicle Modifications

Individual Group - Blended Purchase / Installation / Testing Response Center Monitoring Individual Group - Blended Individual Tier A - Group of 2-8 Tier B - Group of 2-8 Tier C - Group of 2-8 Tier D - Group of 2-8 Tier E - Group of 2-8 Base Camp - Overnight In-Home (CCR Only) Self-Directed Employee Individual Group - Blended Per Person / Per Month Individual Tier A - Group of 2-8 Tier B - Group of 2-8 Tier C - Group of 2-8 Tier D - Group of 2-8 Tier E - Group of 2-8 Base Self-Directed Employee Transportation Provider / SelfDirected Employee

Standard Rate per Unit $7.01 $11.89 R&C $16.25 $6.09 R&C R&C $26.61 $7.60 R&C R&C $27.58 $7.88 $12.73 $2.68 $3.40 $4.24 $6.37 $8.49 $4.78 $76.40 $141.04 R&C $25.99 $7.43 $239.81 $13.25 $2.79 $3.53 $4.42 $6.62 $8.83 $6.09 R&C

Billing Unit 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes Single Month 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes Daily Daily Single 15 Minutes 15 Minutes Month 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes

** Waiver Program n/a 07 n/a 07 n/a 07 46 n/a 46 n/a 46 n/a 46 n/a 46 07 46 07 46 07 46 07 46 07 46 07 46 07 46 07 46 07 46 07 46 07 46 07 46 07 46 07 46 07 46 07 46 07 46 07 46 07 46 07 46 07 46 07 46 07 46 07 46 07 46 n/a 46 n/a

Medicaid Code H2016HI H2016HI22 H2016HIU8 T1013HI22 T1013HI T1013HI52 S5110HI 97535HI 97535HIUN S5160HI S5161HI S8990HI S8990HIUN T2015HI22 T2015HIUS T2015HIUR T2015HIUQ T2015HIUP T2015HIUN T1005HI T2036HI S9125HI T1005HI52 92507HI 92507HIUN T2024HI T2019HI T2019HIUS T2019HIUR T2019HIUQ T2019HIUP T2019HIUN T2041HI22 T2041HIU7

$0.74

Mile

46

07

A0090HI22

R&C

Single

46

07

T2039HI

R&C = Reasonable and Customary * Use of Tier and Acuity Differentiated rates are determined through completion of the New Jersey Comprehensive Assessment Tool (NJ CAT) ** Waiver Program: Code "46" refers to the Supports Program under the Comprehensive Medicaid Waiver and Code "07" refers to the Division of Developmental Disabilities Community Care Waiver (CCW)

NJ DHS - DDD For Use: July 1, 2015

2